Basic Information
| Provider Information | |||||||||
| NPI: | 1710487863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADDALA | ||||||||
| FirstName: | ASHWINI | ||||||||
| MiddleName: | N | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 762 | ||||||||
| Address2: | |||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950310762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085408712 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 CLARK WAY | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943042300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503265530 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 100272 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.